PSYCH/660 Week 4 Case Study Two Worksheet: Ethical Dilemma Analysis (University of Phoenix)

Respond to the Case Study Two worksheet questions in 1,250 to 1,500 words, applying the APA Ethical Principles and Code of Conduct to a clinical dilemma involving a minor, cultural pressure, and mandatory reporting obligations. The worksheet carries the full Week 4 individual assignment weight in PSYCH/660 Ethics and Professional Issues.

Assessment Context

The University of Phoenix runs PSYCH/660 as a graduate course in the Master of Science in Psychology program. The course reviews professional and ethical responsibilities of psychological researchers and practitioners, and it uses case studies to test whether students can move from knowing the APA Ethics Code to applying it under pressure. Week 4 shifts from general principles to a specific clinical dilemma. Case Study Two places Dr. Matthews in a session with Irina, a minor whose parents do not want a sexual assault discussed because of cultural concerns about marriageability. The worksheet format is deliberate: the questions force students to address confidentiality, parental rights, state law, HIPAA, and multiple APA standards in sequence. The submission closes at the end of Week 4 in the University of Phoenix LMS. APA 7th edition governs citation and formatting.

Learning Outcomes

Completing this worksheet allows students to:

• Identify the ethical dilemma in a clinical case and explain which APA Ethical Principles frame the conflict.
• Analyze how a client’s age, parental involvement, state law, and HIPAA interact to constrain the psychologist’s options.
• Apply specific APA Ethical Standards, including 2.01, 2.04, 3.04, 3.06, 4.01, 4.02, and 10.10, to the facts of the case.
• Determine what additional standards may apply and explain how they change the analysis.
• Propose a resolution pathway that satisfies legal obligations without abandoning the therapeutic relationship.

Task Instructions

Read Case Study Two in the course textbook appendix. Complete the University of Phoenix worksheet by responding to each question in full sentences. The total response should fall within 1,250 to 1,500 words. Do not use bullet points or numbered fragments inside the worksheet cells; write in paragraph form.

Question 1: The Ethical Dilemma

Explain why this situation constitutes an ethical dilemma. Identify which APA Ethical Principles help frame the nature of the dilemma. State the competing obligations directly rather than describing the case in general terms. The response should make clear what Dr. Matthews owes to Irina, what she owes to the parents, and what she owes under law. Name the specific principles (Beneficence and Nonmaleficence, Fidelity and Responsibility, Integrity, Justice, Respect for People’s Rights and Dignity) that pull in different directions.

Question 2: Age, Parents, and the Law

Analyze how Irina’s age and her parents’ involvement in the referral affect Dr. Matthews’s ability to resolve the dilemma. Address the state law on treatment of minors and the HIPAA rule on guardian access to a minor’s health care record. Explain how each legal framework either expands or narrows Dr. Matthews’s discretion. Do not treat the parents as adversaries; analyze their legal position accurately. The response should distinguish between what the parents can consent to, what they can access, and what Dr. Matthews must report regardless of parental preference.

Question 3: APA Standards Application

Explain how APA Ethical Standards 2.01a, b, and c; 2.04; 3.04; 3.06; 4.01; 4.02; and 10.10a apply to this case. For each standard, state what the standard requires and then show how the requirement bears on a specific fact from the case. A generic definition of the standard without case application does not satisfy the requirement. Identify at least two additional standards that might apply and explain why.

Question 4: Resolution

Propose how Dr. Matthews should proceed. Address the immediate session, the disclosure to the parents, the report to authorities, and the ongoing therapeutic relationship with Irina. Explain how the resolution protects Irina’s safety, respects the parents’ legal role where the law allows, and satisfies Dr. Matthews’s ethical obligations. Acknowledge any residual tension that the resolution does not eliminate.

Marking Criteria

The worksheet is scored against the University of Phoenix graduate rubric for written assignments. The rubric rewards application over description and penalises responses that define ethical concepts without tying them to the case.

• Dilemma identification: The competing obligations are named accurately and tied to specific APA Ethical Principles. The response shows why the situation is a dilemma rather than a simple compliance question.
• Legal and developmental analysis: State law on minors, HIPAA guardian access, and the parents’ cultural position are analyzed as constraints, not as obstacles to be dismissed.
• Standards application: Each required APA standard is applied to a specific fact. The response distinguishes between standards that create obligations and standards that create permissions.
• Resolution quality: The proposed course of action is legally and ethically defensible, addresses immediate safety, and preserves the therapeutic relationship where possible.
• Writing and APA format: The response is organized, proofread, and cites the APA Ethics Code and any state law sources in APA 7th edition.

Example Student Response

The ethical dilemma arises from a collision between Dr. Matthews’s duty to protect Irina’s welfare and her duty to respect the parents’ legal authority over their minor daughter’s treatment. The parents want the sexual assault left unaddressed because disclosure would damage Irina’s marriage prospects within their cultural community. Irina shares that fear. The principle of beneficence obligates Dr. Matthews to address the trauma that is already affecting Irina’s functioning, while the principle of respect for people’s rights and dignity obligates her to take the family’s cultural context seriously rather than treating it as an obstacle to override. Fidelity and responsibility adds a third obligation: Dr. Matthews must maintain the trust that makes the therapeutic relationship workable. The APA Ethics Code does not resolve this collision by ranking the principles. It requires Dr. Matthews to reason through the specific facts, identify the legal boundaries, and act in a way that protects Irina without unnecessary harm to the family relationship (American Psychological Association, 2017). The worksheet questions force that reasoning into the open.

Irina’s status as a minor changes the analysis at every level. Her parents hold legal authority to consent to treatment and to access her health records under HIPAA, with exceptions that vary by state. That authority is not unlimited. State mandatory reporting laws require Dr. Matthews to report suspected sexual abuse regardless of parental preference, and those laws sit outside the parents’ consent power. The worksheet asks how the state law on treatment of minors and the HIPAA rule influence Dr. Matthews’s decision. The answer is that they narrow her options in opposite directions. HIPAA gives the parents a strong claim to information about Irina’s care. Mandatory reporting law overrides that claim where abuse is at issue. Dr. Matthews cannot promise the parents confidentiality that the law will not let her keep. She can, however, explain the legal obligation before the report is made, involve the parents in the process where safe, and structure the disclosure in a way that preserves Irina’s safety and the family’s willingness to continue treatment (Behnke & Warner, 2023).

Mandatory Reporting and Therapeutic Trust

A frequent search question concerns whether reporting the assault destroys the therapeutic alliance. The empirical literature on minor consent and confidentiality suggests that adolescents often anticipate negative consequences from disclosure and may withhold information when confidentiality is uncertain (Boonstra & Nash, 2024). The worksheet does not ask Dr. Matthews to choose between reporting and the alliance. It asks her to manage both. A defensible resolution explains the legal obligation to Irina in developmentally appropriate language, involves her in deciding how and when the parents are told where safety permits, and documents the reasoning. Standards 3.04 (avoiding harm) and 3.06 (conflict of interest) become relevant here because Dr. Matthews must not let the parents’ cultural pressure become a conflict that compromises her clinical judgment.

What the Rubric Rewards in the Standards Section

A common mistake is to define each APA standard in a sentence and then move on. The rubric expects the student to show what Standard 4.01 (maintaining confidentiality) requires in a case where mandatory reporting law overrides confidentiality, and then to name the specific fact that triggers the override. The same logic applies to Standard 10.10a (informed consent to therapy). Irina’s age and the parents’ involvement mean that consent is not a single event. Dr. Matthews must obtain assent from Irina and consent from the parents, and she must explain the limits of confidentiality at the outset. Students who treat 10.10a as a checkbox miss the point that the standard requires a process, not a signature. Standards 2.01 and 2.04 concern competence and bases for professional judgments. A strong response ties those standards to Dr. Matthews’s obligation to consult cultural competence resources and to seek supervision when the case exceeds her existing knowledge.

Conclusion

The worksheet tests whether a student can hold a legal obligation and a therapeutic obligation in the same analysis without letting one erase the other. Dr. Matthews cannot avoid reporting the assault, and she cannot pretend that the parents’ cultural concerns are irrelevant to Irina’s wellbeing. The strongest responses show how those two facts coexist. They name the standards, apply them to specific case details, and propose a resolution that a real clinician could defend in a case conference. The word range is tight because the worksheet does not reward padding. It rewards precision about which obligation applies, when it applies, and what the psychologist does next.

References

• American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). https://www.apa.org/ethics/code
• Behnke, S. H., & Warner, J. (2023). Confidentiality in the treatment of adolescents. Monitor on Psychology, 54(2), 44–47.
• Boonstra, H. D., & Nash, E. (2024). Minors and the right to consent to health care. Guttmacher Policy Review, 27(1), 12–19.
• Fisher, C. B. (2022). Decoding the ethics code: A practical guide for psychologists (5th ed.). SAGE Publications.

PSYCH/660 Week 4 Case Study Two Worksheet: Ethical Dilemma Analysis

Question 1: The Ethical Dilemma

Dr. Matthews faces an ethical dilemma because Irina’s disclosure of sexual assault creates competing duties that cannot all be satisfied at the same time. She owes Irina protection from further harm, competent trauma-informed care, and a therapeutic relationship in which Irina can speak safely. She also owes Irina’s parents respect for their legal role as guardians and sensitivity to the cultural pressure surrounding disclosure. At the same time, she owes the state compliance with mandatory child-abuse reporting law, which may require disclosure regardless of the family’s wishes. The situation is therefore more than a simple choice between confidentiality and reporting; it requires Dr. Matthews to balance protection, legal authority, cultural context, and professional responsibility.

The APA Ethical Principles frame the competing obligations. Beneficence and Nonmaleficence require Dr. Matthews to promote Irina’s welfare and avoid harm, including the harm caused by untreated trauma or continued exposure to an unsafe situation (American Psychological Association [APA], 2017). Fidelity and Responsibility require her to maintain trust, follow professional obligations, and accept responsibility for the consequences of her decisions. Integrity requires honest communication with Irina and her parents, particularly about the limits of confidentiality. Justice requires Dr. Matthews to give Irina fair access to protection and care despite her age, family circumstances, or cultural background. Respect for People’s Rights and Dignity requires Dr. Matthews to recognize Irina’s privacy and autonomy to the extent legally possible, while also respecting the parents’ legitimate role in their minor child’s care.

The dilemma becomes acute because the parents’ cultural concern about marriageability is not irrelevant to Irina’s welfare. If disclosure leads to family conflict, isolation, or loss of support, Irina may experience additional harm. However, declining to report suspected sexual abuse could leave Irina at risk and would place Dr. Matthews in violation of state law. Dr. Matthews must therefore protect Irina without treating the family as an enemy or dismissing the cultural factors that shape their response. The ethical task is to identify the legally required action, minimize unnecessary harm, and preserve as much therapeutic trust as possible (APA Services, 2025).

Question 2: Age, Parents, and the Law

Irina’s status as a minor substantially narrows Dr. Matthews’s discretion. Because Irina is not an adult, her parents generally have legal authority to consent to treatment, receive information about care, and act as her personal representatives under HIPAA. The U.S. Department of Health and Human Services explains that parents ordinarily may access a minor child’s protected health information when doing so is consistent with state or other applicable law (U.S. Department of Health and Human Services [HHS], 2024). This legal position means Dr. Matthews cannot simply exclude the parents from Irina’s treatment or promise Irina absolute confidentiality.

State law, however, limits parental authority where abuse is suspected. Most states require psychologists and other mandated reporters to report suspected child abuse or neglect, and that reporting duty generally supersedes patient confidentiality (APA Services, 2025). If Irina’s disclosure meets the legal threshold for suspected sexual abuse, Dr. Matthews must make a report to the appropriate child-protection or law-enforcement authority. The parents cannot consent away that obligation, and their preference that the assault remain undisclosed does not remove Dr. Matthews’s legal duty. Mandatory reporting law therefore expands Dr. Matthews’s obligation to act while narrowing her ability to keep the information private.

HIPAA and state law interact in a more complicated way. HIPAA generally recognizes a parent as the personal representative of a minor, but it defers to state law when state law specifically addresses parental access to a minor’s health information (HHS, 2024). Some states may restrict parental access when disclosure would endanger the minor or when the minor has legal authority to consent to particular services. Even where parents may access records, Dr. Matthews should disclose only the information necessary for the legal purpose and avoid sharing unnecessary clinical details. The parents may have a right to know about treatment and safety concerns, but they do not have an unlimited right to control every therapeutic decision or to prevent a legally mandated report.

The parents’ cultural concerns must be treated as a real constraint rather than dismissed. Their fear that disclosure will affect Irina’s marriage prospects may influence Irina’s willingness to continue treatment and may affect the family’s capacity to support her. Dr. Matthews should explain that the law requires action when abuse is suspected, while also acknowledging the parents’ concern for Irina’s future. She can involve the parents in safety planning, explain the purpose of the report, and identify culturally respectful supports where appropriate. The legal framework does not make the parents adversaries; it defines the boundaries within which Dr. Matthews must work.

Question 3: APA Standards Application

Standard 2.01a requires psychologists to provide services only within the boundaries of their competence, based on education, training, supervised experience, consultation, study, or professional experience. Dr. Matthews must assess whether she has sufficient competence to work with a minor who has experienced sexual assault. If she lacks training in child trauma, forensic interviewing, or mandated reporting, she should seek supervision or consultation rather than relying on general clinical experience. Standard 2.01b requires psychologists to remain current in scientific and professional knowledge, which applies because trauma treatment, child development, and reporting law can change. Standard 2.01c requires psychologists to undertake ongoing efforts to develop and maintain competence, making continued education and consultation particularly important in a culturally sensitive abuse case.

Standard 2.04 requires psychologists’ work to be based on established scientific and professional knowledge. Dr. Matthews should ground her assessment and treatment plan in recognized trauma-informed practices rather than personal assumptions about culture, family loyalty, or adolescent development. For example, she should avoid assuming that Irina’s parents are abusive simply because they oppose disclosure. Instead, she should gather information carefully, assess immediate safety, and use appropriate clinical and legal resources. The standard requires Dr. Matthews to distinguish between cultural practices, family pressure, and evidence of ongoing risk.

Standard 3.04 requires psychologists to take reasonable steps to avoid harming clients and to minimize foreseeable harm. In this case, the standard applies directly to Irina’s safety and emotional wellbeing. Dr. Matthews must consider both the harm of failing to report suspected abuse and the possible harm caused by an abrupt or poorly explained disclosure to the parents. She should prepare Irina for what will happen, use developmentally appropriate language, and avoid exposing Irina to unnecessary shame or retaliation. Avoiding harm does not mean avoiding the report; it means carrying out the report in a way that protects Irina as fully as possible.

Standard 3.06 requires psychologists to refrain from taking on professional responsibilities when personal, scientific, professional, legal, financial, or other interests could reasonably impair their objectivity. The parents’ cultural pressure could create a conflict if Dr. Matthews allows fear of family conflict, community criticism, or professional discomfort to influence her judgment. She must keep the focus on Irina’s safety, legal obligations, and clinical needs. If Dr. Matthews feels personally pressured by the parents or uncertain about the legal threshold, consultation with a supervisor, ethics committee, or attorney is appropriate.

Standard 4.01 requires psychologists to protect confidential information and to establish safeguards appropriate to the nature of the information. Irina’s disclosure is highly sensitive, so Dr. Matthews must limit access to the information, store records securely, and disclose only what is legally required. The standard does not make confidentiality absolute. When state law mandates a report of suspected abuse, Standard 4.05 permits and requires disclosure without Irina’s consent (APA, 2017). Dr. Matthews should therefore protect confidentiality to the extent possible while complying with the reporting mandate.

Standard 4.02 requires psychologists to discuss the limits of confidentiality as early as feasible in the therapeutic relationship. Dr. Matthews should explain, in language Irina can understand, that information about abuse may have to be reported to authorities. She should also explain that the report is intended to protect Irina, not to punish her or expose her unnecessarily. If Dr. Matthews did not fully explain these limits before the disclosure, she should do so now, before making the report where safety and legal timing permit. Clear communication can reduce Irina’s sense of betrayal and preserve some trust in the therapeutic relationship.

Standard 10.10a requires psychologists to obtain informed consent for therapy from the client or a legally authorized person, using language that is reasonably understandable. Because Irina is a minor, consent involves both the parents’ legal authorization and Irina’s assent. Dr. Matthews should explain the purpose of therapy, the role of the parents, the limits of confidentiality, and the possibility of mandated reporting. Informed consent is not a single signature; it is an ongoing process that should continue as new safety concerns and legal obligations arise. Irina’s age and developmental level require Dr. Matthews to adapt the explanation so that Irina understands what will happen and why.

Two additional standards are relevant. Standard 3.09, Cooperation with Other Professionals, applies because Dr. Matthews may need to coordinate with child-protection services, medical providers, school personnel, or legal professionals while protecting Irina’s interests. Standard 4.05, Disclosures, is also directly relevant because it permits disclosure without consent when required by law or when necessary to provide services, obtain consultation, or protect the client from harm (APA, 2017). These standards reinforce that Dr. Matthews should act through appropriate professional channels rather than making an isolated decision based on fear or cultural pressure.

Question 4: Resolution

Dr. Matthews should begin by assessing immediate safety during the current session. She should ask Irina whether she is safe at home, identify any continuing risk, and determine whether the alleged perpetrator has access to Irina. If there is imminent danger, Dr. Matthews should follow emergency procedures, contact appropriate authorities, and avoid leaving Irina in an unsafe setting. She should speak with Irina in a calm, nonjudgmental manner and explain that the disclosure was brave and important. The immediate priority is Irina’s physical and psychological safety, not resolving the parents’ cultural concerns.

Before making a report, Dr. Matthews should consult the applicable state mandatory-reporting law and, where necessary, seek guidance from a supervisor, ethics consultant, or legal authority. If the facts meet the reporting threshold, she should make the required report promptly and accurately. The report should include only the information necessary to meet the legal requirement, such as the nature of the suspected abuse, relevant identifying details, and immediate safety concerns. Dr. Matthews should document the decision, the legal basis for the report, the information disclosed, and any consultation received. Documentation protects Irina, supports continuity of care, and demonstrates that Dr. Matthews acted within professional and legal boundaries (APA, 2019).

Dr. Matthews should then decide how to communicate with the parents. She should explain that suspected abuse triggers a legal reporting duty that she cannot ignore. She should avoid blaming the parents, debating cultural beliefs, or revealing more clinical detail than necessary. Instead, she should frame the report as a legal and safety obligation and invite the parents to participate in Irina’s care where doing so is safe and appropriate. If the parents are supportive, Dr. Matthews can help them understand how to respond without shaming, isolating, or pressuring Irina. If the parents are hostile or may retaliate, Dr. Matthews should limit disclosure to what the law requires and coordinate with child-protection authorities.

The ongoing therapeutic relationship requires careful repair. Dr. Matthews should acknowledge Irina’s fear, validate her courage, and explain that reporting was not a betrayal of trust. She should give Irina age-appropriate choices where possible, such as deciding what she wants to share in future sessions or identifying a trusted adult who can support her. Treatment should focus on trauma symptoms, safety planning, emotional regulation, and rebuilding a sense of control. Dr. Matthews should continue to assess risk at each session because disclosure can change family dynamics and may increase Irina’s vulnerability.

Residual tension will remain even after Dr. Matthews follows the correct process. Reporting may strain the relationship with Irina’s parents, and Irina may feel exposed or angry despite Dr. Matthews’s careful explanation. Cultural concerns about marriageability may continue to affect the family’s response. Dr. Matthews cannot eliminate these tensions, but she can manage them ethically by being transparent, protecting Irina’s safety, respecting the parents’ lawful role, and maintaining professional boundaries. The strongest resolution is not a choice between reporting and preserving the therapeutic relationship; it is a carefully documented process that fulfills the legal duty while treating Irina and her family with dignity.

References

American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). https://www.apa.org/ethics/code/ethics-code-2017.pdf

APA Services. (2025, August 22). Mandatory reporting. https://www.apaservices.org/practice/legal/patient-confidentiality/mandatory-reporting

APA Services. (2025, August 28). Mandatory reporting: What practicing psychologists need to know. https://www.apaservices.org/practice/legal/patient-confidentiality/what-psychologists-need-to-know

Fisher, C. B. (2022). Decoding the ethics code: A practical guide for psychologists (5th ed.). SAGE Publications.

U.S. Department of Health and Human Services. (2024). Personal representatives and minors. https://www.hhs.gov/hipaa/for-professionals/faq/personal-representatives-and-minors/index.html

U.S. Department of Health and Human Services. (2024). HIPAA privacy rule and sharing information related to mental health. https://www.hhs.gov/sites/default/files/hipaa-privacy-rule-and-sharing-info-related-to-mental-health.pdf